Basic Information
| Provider Information | |||||||||
| NPI: | 1568757169 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WENNER | ||||||||
| FirstName: | DARRYL | ||||||||
| MiddleName: | CHARLES DANIEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6075 POPLAR AVE | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381194740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168637948 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 224 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141411443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165922871 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2011 | ||||||||
| LastUpdateDate: | 05/22/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | NY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208M00000X | 269910 | NY | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 269910 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.